Validation of a clinical prediction rule to reduce preoperative type and screen procedures{dagger}{dagger}{dagger}

doi:10.1093/bja/aef139

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British Journal of Anaesthesia, 2002, Vol. 89, No. 2 221-225
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia

Clinical Investigations

Validation of a clinical prediction rule to reduce preoperative type and screen procedures

W. A. van Klei^*^,1^,2, K. G. M. Moons¹^,2, A. T. Rheineck-Leyssius³, C. J. Kalkman¹, C. L. G. Rutten⁴, J. T. A. Knape¹ and D. E. Grobbee²

¹ Department of Peri-operative Care, Anaesthesia and Pain Management, ² Julius Centre for General Practice and Patient Oriented Research, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. ³ Twenteborg Hospital, Department of Anaesthesiology and Intensive Care Medicine, Zilvermeeuw 1, 7609 PP Almelo, The Netherlands. ⁴ Isala Clinics, Department of Anaesthesiology, Weezenlanden Hospital, PO Box 10500, 8000 GM Zwolle, The Netherlands*Corresponding author

${dagger}$ Presented in abstract form at the ASA annual meeting, October 2001, New Orleans, USA.
${dagger}$ ${dagger}$ This article is accompanied by Editorial II.

Background. We have developed a prediction rule for the occurrenceof perioperative red blood cell transfusion to help to reducethe number of unnecessary preoperative type and screen procedures.We evaluated the robustness of this prediction rule in patientsfrom another hospital.

Methods. The rule was retrospectively applied to 1282 consecutivepatients (‘validation set’) who underwent similarsurgical procedures to the patients in the derivation study.The outcome was similarly defined as any allogeneic transfusionon the day of surgery or during the first postoperative day.The predictive value of the rule was assessed using a ReceiverOperating Characteristic curve (ROC) and compared with the resultsof the derivation study. Subsequently, the number of correctlypredicted transfusions was compared.

Results. The patient characteristics did not differ betweenthe two sets, except for the incidence of transfusion (derivationstudy: 18%; present study: 8%). In the validation set, the ROCarea of the prediction rule was 0.78 (95% confidence intervals[CI]: 0.73–0.82), which was within the CI of the ROC areafound in the derivation study (0.75; 95% CI: 0.72–0.79).In total, 35% of the type and screen procedures could be omitted(derivation study: 50%), with 13% missed transfused patients(derivation study: 20%).

Conclusions. After comparing the results of this validationstudy with that of the derivation study, the prediction rulewas robust and may work in other clinics as well.

Br J Anaesth 2002; 88: 221–5

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This article has been cited by other articles:

J. C. Howie and P. J. Tansey
Editorial II: Blood transfusion in surgical practice--matching supply to demand
Br. J. Anaesth., August 1, 2002; 89(2): 214 - 216.
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